RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01009
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Heavy Wheeled Vehicle Mechanic, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Extreme pain while doing many daily activities.  Standing bending all increase pain in normal workplace.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20050413	VARD - 20060127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Chronic Lumbosacral Strain with Arthritis	5237	20%	20051110	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in January 2004 after loading boxes.  An MRI revealed degenerative changes at L3-4, L4-5 and L5-S1 with neuroforaminal narrowing (stenosis).  Conservative therapy did not resolve the back pain, and the CI did not wish to explore surgical options.  At the 24 August 2004 PT evaluation, 10 months prior to separation, the CI complained of continued back pain.  On examination, there was severe guarding.  Range of motion (ROM) testing showed flexion decreased by 25%, but all other planes of motion were normal.  

During the 24 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported back pain.  Physical examination showed normal spinal and neurologic evaluations.  Thoracolumbar ROM measurements performed by PT on 17 March 2005, 3 months prior to separation, showed flexion of 20 degrees (normal 90) and combined ROM of 105 degrees (normal 240), after repetition, limited by pain.  Passive ROMs were reported within 5 degrees of active ROMs in all planes).  The examiner indicated the CI had “increased pain with all movements and knees continued to buckle.  Also numbness in right thigh area.” 

The 23 March 2005 MEB NARSUM examination noted complaints of severe back pain with continual intermittent bilateral lower extremity weakness, described as buckling.  Physical examination showed lumbar paraspinal tenderness with evidence of hypertrophied paraspinal muscle.  There was decreased ROM of the lumbar spine.  Straight leg raise showed pain at 60 degrees bilaterally.  There was decreased strength (4/5) of the “iliopsoas bilaterally, thought to be breakthrough of pain,” with otherwise normal lower extremity strength.  Tandem gait was without difficulty and toe raises bilaterally showed normal strength (5/5).  

At the 10 November 2005 VA Compensation and Pension (C&P) general examination, 5 months after separation, the CI reported sharp 8/10 back pain on a daily basis, increasing to 10/10 with flare-ups.  Physical examination showed “a slow, mild antalgic gait.”  The VA spine examination, the same day, revealed a normal spinal contour with lumbosacral tenderness, but no muscle spasms.  Thoracolumbar ROM measurements showed flexion of 70 degrees and combined ROM of 210 degrees, after repetition, limited by pain.  The CI was able to ambulate on both heels and toes and was able to squat.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbar spine strain), citing tenderness and ROM decreased secondary to pain, with likely application of AR 635-50, B-29 (in effect at the time), which indicated “ratings for loss of joint motion can only be awarded where a mechanical basis for limited motion is found,” and not joint pain resulting in loss of motion.  The VA rated the lumbosacral strain 20%, also coded 5237, based on the C&P examination, citing an additional evaluation being granted based on the subjective and objective findings of limitation of motion due to pain, functional impairment due to pain and increased pain with repetitive motion.  

The panel deliberated on the probative value of the examinations in evidence.  The panel noted the limitation of thoracolumbar motion recorded in the MEB NARSUM examination met the threshold for a 40% rating.  However, the panel observed that the PT ROM examination was an outlier to all other STR evidence, and was consistent with a flare of back pain that responded to treatment, resulting in improved ROM over time.  Panel members agreed the VA examinations, performed about the same time relative to separation, were more consistent with outpatient notes and more reflective of the anticipated severity based on the clinical pathology.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA spine examination proximate to separation.  There was painful motion with an antalgic gait noted on the VA general examination that same date with no other ratable condition attributed to the antalgic gait.  Although the antalgic gait was not specified as due to the back condition, the panel adjudged that the next higher 20% spine rating was justified on this basis.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5237.  
BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	20%	

XXXXXXXXXX

Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.